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Query: UMLS:C0030305 (pancreatitis)
 16,014 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Specific features of diagnostics and surgical treatment of injuries of the duodenum in 41 patients with open and closed traumas of the abdomen are described. A wide access by means of mobilization of the right colic flexure should be used for the revision of the duodenum. In cases with closed injuries of the duodenum, in addition to maintenance of its reliable decompression, it is necessary to exclude the intestine from the passage of the gastric content. In order to prevent postoperative pancreatitis cholecystostoma should be made.
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PMID:[Characteristics of the diagnosis and surgical treatment of injuries of the duodenum]. 265 72

Pancreatitis, commonly encountered in the Emergency Department, possesses a very broad clinical spectrum and may be associated with shock and multiple organ failure. Its diagnosis is based on clinical, laboratory, and radiographic data, but there is no gold standard. Biliary tract disease ranges in severity from cholelithiasis with colic to acute suppurative cholangitis, which may lead to shock. Clinical examination and imaging studies are most useful in these disorders, and definitive treatment is primarily surgical.
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PMID:Acute diseases of the pancreas and biliary tract. Management in the emergency department. 266 56

Visceral artery aneurysms are uncommon. During the period 1975-88, 32 patients were treated at the Royal Melbourne Hospital for true and false visceral artery aneurysms. There were 18 males and 14 females, with an age range of 12-86 years. Of the 32 patients, 26 were symptomatic and six were asymptomatic. True aneurysms were found in 20 patients and false aneurysms in 10. A further two were dissecting aneurysms. Of the arteries involved, 17 were renal, six were hepatic, five were splenic, one was superior mesenteric, one was left colic and there were two patients with aneurysms at multiple sites. Aetiological factors included atherosclerosis, fibromuscular dysplasia, pancreatitis, and trauma. Only one patient presented in pregnancy. Rupture occurred in 12 patients and two died as a result of this complication. All the true hepatic artery aneurysms presented in this way. Pre-operative investigations included plain radiology, computerized tomography with contrast, nuclear scanning and selective angiography. Operative treatment was required in 22 cases, 12 as an emergency and 10 as an elective procedure. Surgical options included aneurysm excision with or without arterial reconstruction, aneurysmorrhaphy with flap arterioplasty, or ligation of the aneurysm. Embolization was successfully employed in two patients and eight were merely observed without complications. Surgical therapy is recommended for any patient with symptoms, for any woman of child-bearing age and for all hepatic artery aneurysms.
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PMID:Aneurysms of the visceral arteries. 271 13

During the past decade, 246 infants and children treated at the Columbus Children's Hospital have required more than 4 weeks of parenteral nutrition (PN). Of the 178 survivors, 70 returned for evaluation. Sixty-eight either had adequate visualization of the gallbladder by ultrasound or had previous gallbladder surgery (39%). Of 68 children who did not survive, complete postmortem examinations or ultrasound studies were available for 16 (24%). A diagnosis of cholelithiasis was established in 11 of the 84 studied patients (13%). Six of these children (55%) have required cholecystectomy for relief of chronic abdominal pain, pancreatitis, or empyema of the gallbladder. One additional infant underwent cholecystostomy. Two of the four remaining patients are asymptomatic, one has episodes of abdominal colic, and one child expired of chronic hepatic insufficiency as a result of PN-associated cholestasis. Risk factors that predisposed these children to cholelithiasis included short bowel syndrome, lack of an ileocecal valve, and an increased number of abdominal operative procedures (P less than .05). Patients with biliary calculi also had a longer duration of parenteral feeding, and a higher incidence of both PN-associated cholestasis and necrotizing enterocolitis. The intergroup differences for these characteristics, however, did not achieve statistical significance. On the basis of this information, routine ultrasound examinations of the gallbladder are recommended for children maintained on PN for longer than 30 days. All patients presenting with abdominal pain who previously received PN should also be evaluated. Early elective cholecystectomy is suggested for children who develop PN-associated cholelithiasis.
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PMID:Parenteral nutrition with associated cholelithiasis: another iatrogenic disease of infants and children. 311 62

Lead has a multiplicity of biologic effects. The universal occurrence of lead accounts for the continuous appearance of new instances of human lead poisoning. The most common and one of the earliest manifestations of lead intoxication in the adult is so-called lead-induced colic, which is a syndrome with a multiplicity of clinical patterns and at least three possible different pathogenic mechanisms. It may be caused by changes in the visceral smooth muscle tone secondary to the action of lead on the visceral autonomic nervous system, lead-induced alterations in sodium transport in the small-intestinal mucosa, and lead-induced interstitial pancreatitis. It should be considered in the differential diagnosis of abdominal pain of obscure etiology and whenever a disparity is observed between the symptoms and the abdominal findings in a patient with abdominal pain, especially in the presence of a history of occupational exposure to lead.
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PMID:The "lead-induced colic" syndrome in lead intoxication. 315 32

During the last 12 years, we performed 78 reoperations upon the biliary tract for benign disorders. Not included were early complications after the initial operation or endoscopic manipulation. The indications for reoperations were obstructive jaundice, recurrent colic and asymptomatic biliary fistula in 57, 18 and three patients, respectively. Endoscopic retrograde cholangiography was found to be the preoperative diagnostic method of choice. Intraoperative examination demonstrated cholangiolithiasis in 48 patients (five patients with stenosis), stenosis of the bile duct in eight, sump syndrome after choledochoduodenostomy in six and cholangitis without any further pathology in three. In three patients, the revision was negative. Several reinterventions were carried out: exploration of the bile ducts (12 per cent with papillotomy), removal of a biliodigestive anastomosis and a biliary enteric anastomosis in 52, 12 and 14 patients, respectively. The postoperative cholangiogram showed residual stones in 12 patients. Two-thirds of the stones disappeared spontaneously and one-third were removed endoscopically. There were local complications in 12 of the patients. The mortality rate was 6.4 per cent. All of these patients were more than 70 years old and were considered at high risk. In spite of endoscopic retrograde cholangiography, the number of operative reinterventions upon the biliary duct system has hardly declined over the last few years. This is partly due to new specific complications in connection with endoscopic retrograde endoscopy (perforation, hemorrhage or pancreatitis).
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PMID:Reoperations upon the biliary duct system for benign disorders are still indicated. 379 11

The authors present a case of intestinal subocclusion due to chronic pancreatitis and peripancreatitis, in which the relationship between the cause and the effect could not be established before surgery. The intervention consisted in caudal pancreatectomy and the freeing of the splenic angle of the large bowel from the peripancreatitic process. This rare complication of pancreatitis is diagnosed mostly during surgery, and the surgeon is confronted with a difficult choice of the best type of intervention, which can vary from simple viscerolysis to exeresis of the colic segment and of the caudal portion of the pancreas.
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PMID:[Intestinal sub-occlusion caused by chronic caudal pancreatitis]. 645 64

Colonic complications of pancreatitis are not infrequent occurrences, as illustrated by the fact that the authors have personally treated 39 such cases. Lesions are found in the colon at sites which correspond perfectly to diffusion of pancreatic necrotic lesions along mesenteric pathways as described by Meyers. They occur mainly in the left colic flexure (17 cases) and transverse colon (10 cases) but may affect the ascending (6 cases) and descending (4 cases) colon by diffusion of the pancreatitis into the anterior extrarenal space. These topographical characteristics, associated with the extrinsic and inflammatory nature of the lesions, produce a very specific and typical radiological syndrome which should assist diagnosis.
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PMID:[Colonic complications of pancreatitis. A report on 39 cases (author's transl)]. 736 24

A retrospective analysis was done of 88 cases of laparoscopic cholecystectomy performed by the first author from November 1990 to March 1992 at the Toa Payoh Hospital. There were 61 female and 27 male patients; the average age was 47.1 years. The most common presenting symptom was biliary colic (85.3%), followed by acute cholecystitis (10.2%) and gallstone pancreatitis (4.5%). In the vast majority of patients, the diagnosis was established by ultrasound (96.6%) while the remainder was diagnosed by oral cholecystography (3.4%). The operation was performed using the usual 4 puncture approach with the single-handed technique of dissection. Antibiotic prophylaxis with a broad-spectrum agent was used in all patients and there was no incidence of wound infection. A low complication rate of 4.5% was experienced--consisting of 1 case each of subcutaneous emphysema, abdominal colic, fever and bile duct injury. There was no mortality in our series. The conversion rate was 9.1% and this was due to our policy of performing laparotomy whenever the safety of laparoscopic surgery was in doubt. The mean duration of postoperative hospitalisation was 3 days and 7 days after laparoscopic and converted cholecystectomies respectively. The majority of patients (61.4%) returned to work after 2 weeks.
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PMID:Experience with laparoscopic cholecystectomy at the Toa Payoh Hospital. 826 71

Surgery remains the ideal emergency treatment for biliary lithiasis in elderly subjects despite perioperative morbidity and mortality. Minimally invasive techniques appear promising but require assessment. The aim of this work was to determine the usefulness of these techniques and evaluate outcome in a series of 157 patients over 75 years of age who were hospitalized in an emergency setting of complicated biliary lithiasis from January 1990 to December 1996. There were 103 women and 54 men, mean age 82 years. The patients' general status was evaluated according to the ASA classification; 66% of the patients were ASA III, IV or V. Diagnoses at admission were acute cholecystitis (n = 71, 45%), angiocholitis (n = 50, 31%) subintrant hepatic colic (n = 17, 10.8%), pancreatitis (n = 10, 6%), isolated jaundice (n = 2), peritonitis (n = 2) and occlusion (n = 5). Within 24 hours of admission, 7 patients underwent emergency surgery, and the 150 others were given medical treatment. Among these 150 patients, cure was considered to have been achieved with medical treatment alone in 41 (subsequent surgery being required in only one 6 months later), semi-emergency was performed in 17, and a minimally invasive procedure was performed in the 92 others (echo-guided percutaneous cholecystostomy in 42, endoscopic sphincterotomy in 50) followed by a subsequent operation in 29. In the 103 patients (65.5%) in this series who did not undergo surgery, mortality was 3.8% and in the 54 patients (34.5%) who did, mortality was 15%, but this rate was only 6.9% when the open procedure followed a minimally invasive technique. Surgical treatment of complicated biliary disease remains the ideal therapy but indications should be carefully weighed in these elderly fragilized subjects. Under surgical observation, abstention from surgery or use of minimally invasive techniques can play an important role in the therapeutic strategy aimed at lowering perioperative mortality.
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PMID:[Comments on emergency treatment of biliary lithiasis in patients over 75 years of age. Apropos of 157 cases]. 968 57


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